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目的调查维持性血液透析(maintenance hemodialysis,MHD)患者继发性相对性甲状旁腺功能减退(secondary relative hypoparathyroidism,SRHOP)的发生率,探讨可能的影响因素。方法选择2012年1月至2012年12月在上海市第七人民医院血液净化中心行常规血液透析3个月以上、病情稳定的慢性肾衰患者182例,参照改善全球肾脏病预后组织(KDIGO)指南,统计和分析全段甲状旁腺激素(intact parathyroid hormone,iPTH)达标情况。根据血浆iPTH浓度将患者分为SRHOP组(iPTH<150pg/mL,n=73)和非SRHOP组(iPTH≥150pg/mL,n=109),通过Spearman相关分析和Logistic多元回归分析探讨MHD患者发生SRHOP的可能影响因素。结果 182例MHD患者血iPTH平均浓度为(173.5±114.3)pg/mL,随着患者年龄的增长,血iPTH浓度逐渐下降。参照KDIGO指南,达标者为83例(45.6%),低于标准者为73例(40.1%),高于标准者为26例(14.3%)。达标率在不同性别间差异无统计学意义。SRHOP组患者的年龄、糖尿病发生率、血浆校正钙浓度高于非SRHOP组,而血磷、白蛋白(Alb)水平和标准蛋白氮呈现率低于非SRHOP组(P<0.05)。两组患者的性别构成、透析时间、血压、尿素氮、肌酐、尿素清除指数(Kt/V)、口服钙剂和维生素D的病例数、血红蛋白等指标差异无统计学意义。Spearman相关分析结果显示,患者年龄、是否合并糖尿病、血浆校正钙浓度、血磷水平、Alb水平均与SRHOP有关;Logistic回归分析结果显示,年龄和血磷水平是MHD患者发生SRHOP的独立危险因素。结论 MHD患者更常发生SRHOP而不是继发性甲状旁腺功能亢进,年龄和血磷水平是MHD患者发生SRHOP的独立危险因素。
Objective To investigate the incidence of secondary relative hypoparathyroidism (SRHOP) in maintenance hemodialysis (MHD) patients and explore the possible influencing factors. Methods From January 2012 to December 2012, 182 patients with chronic renal failure who were in stable condition were treated with hemodialysis in Shanghai Seventh People’s Hospital Blood Purification Center for more than 3 months. According to the results of KDIGO, Guide, statistics and analysis of intact parathyroid hormone (intact parathyroid hormone, iPTH) compliance. Patients were divided into SRHOP group (iPTH <150pg / mL, n = 73) and non-SRHOP group (iPTH≥150pg / mL, n = 109) according to plasma iPTH concentration. Spearman correlation analysis and Logistic multiple regression analysis were used to investigate the occurrence of MHD The possible influencing factors of SRHOP. Results The mean blood iPTH concentration in 182 patients with MHD was (173.5 ± 114.3) pg / mL. As the patient’s age increased, the blood iPTH concentration gradually decreased. According to the KDIGO guidelines, 83 patients (45.6%) met the criteria, 73 (40.1%) below the standard, and 26 (14.3%) above the standard. The compliance rate in different genders was no significant difference. The SRHOP group had higher age, diabetes mellitus, and plasma Ca2 + -correlation than non-SRHOP group, while the levels of serum phosphorus, albumin (Alb) and standard protein nitrogen were lower than those in the non-SRHOP group (P <0.05). There were no significant differences in gender composition, dialysis time, blood pressure, urea nitrogen, creatinine, urea clearance index (Kt / V), oral calcium and vitamin D cases, hemoglobin and other indicators of the two groups. Spearman correlation analysis showed that patients’ age, diabetes mellitus, plasma calcium concentration, serum phosphorus level and Alb level were all related to SRHOP. Logistic regression analysis showed that age and serum phosphorus level were independent risk factors of SRHOP in MHD patients. Conclusions Patients with MHD often have SRHOP instead of secondary hyperparathyroidism. Age and serum phosphorus level are independent risk factors for SRHOP in MHD patients.